Advancing enteral feeding volumes

The following is a guideline for the rate of enteral feeding advancement in premature infants. As all babies have differing degrees of feeding tolerance, these guidelines must be adjusted for the individual patient.

The source of enteral nutrition may be a key variable in advancing feeds in premature infants. Infants often tolerate their mother’s expressed breast milk better than preterm formulas; and babies feeds can often be advanced slightly quicker when they are receiving breast milk. For example,

* after reaching 50 cc/kg/d of enteral feeds, infants receiving breast milk may be advanced by 20 cc/kg/d divided BID as tolerated.

Larger, more mature infants who are nippling their feeds well may be advanced more quickly than above. Don’t advance any preterm infant < 34 weeks by > 40 cc/kg/d due to an increased risk of NEC.

Term babies who are able to po feed may be advanced by 5cc each feed or every other feed. Term babies who do not have GI, neuro, or cardiopulmonary issues may even be allowed to ad lib po feed and pace themselves.

See Calcium and Phosphorus: Optimal Intake Guidelines

References:

Anderson DM, Kleigman RM. The relationship of neonatal alimentation practices to the occurrence of endemic necrotizing enterocolitis. Am J Perinatol 1991; 8: 62-7.

McKeown RE, et al. Role of delayed feeding and of feeding increments in necrotizing enterocolitis. J Pediatr 1992; 121: 764-770.

Rayyis SF, et al. Randomized trial of "slow" versus "fast" feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants. J Pediatrics 1999; 134: 293-7.

Kennedy KA, Tyson JE, Chamnanvanakij S. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birht-weight infants. Cochrane Database of Systematic Reviews.   http://www.nichd.nih.gov/cochrane/Kennedy/Kennedy.HTM

Thureen PJ. Early Aggressive Nutrition in the Neonate. Pediatrics in Review 1999; 20: e45-e55. http://www.pedsinreview.org/cgi/content/full/20/9/e45